Provider Demographics
NPI:1356814990
Name:BROOKS, SHONTELL A (NP-C)
Entity Type:Individual
Prefix:
First Name:SHONTELL
Middle Name:A
Last Name:BROOKS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 MOUNTAIN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-7202
Mailing Address - Country:US
Mailing Address - Phone:443-798-7778
Mailing Address - Fax:410-360-1675
Practice Address - Street 1:2528 MOUNTAIN RD STE 101
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-7202
Practice Address - Country:US
Practice Address - Phone:443-798-7778
Practice Address - Fax:410-360-1675
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169423363L00000X, 363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily